American journal of public health
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For a single year, 1983, we compared the actual and estimated morbidity, mortality, and costs attributable to measles, mumps, and rubella with having or not having a childhood immunization program using the combined measles-mumps-rubella (MMR) vaccine. Without an immunization program, an estimated 3,325,000 cases of measles would occur as compared to 2,872 actual cases in 1983 with a program. Instead of an expected 1.5 million rubella cases annually, there were only 3,816 actual cases. ⋯ Expenditures for immunization, including vaccine administration costs and the costs associated with vaccine reactions, totaled $96 million. The resulting benefit-cost ratio for the MMR immunization program is approximately 14:1. The savings realized due to the use of combination rather than single antigen vaccine total nearly $60 million.
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We initiated a program of telephone CPR (cardiopulmonary resuscitation) instruction provided by emergency dispatchers to increase the percentage of bystander-initiated CPR for out-of-hospital cardiac arrest. Cardiac arrests in King County, Washington were studied for 20 months before and after the telephone CPR program began. ⋯ We estimate that four lives may have been saved by the program. A review of hospital records revealed no excess morbidity in the group of patients receiving dispatcher-assisted CPR.
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To evaluate the effectiveness of the trauma care system in the Hudson Valley Emergency Medical Services (EMS) Region, (with no designated regional trauma care center) 421 consecutive trauma autopsy reports for 1979-80 were analyzed. Of the 421 trauma patients, 194 died at the scene (DAS), most from vehicular accidents. The remaining 227 patients were triaged into the EMS system. ⋯ Nearly 60 per cent of the deaths involved brain injuries. A panel of five physician-evaluators examined the pathologist's analysis of those deaths considered to have been possibly preventable and concluded that 10 deaths (7.6 per cent) of in-hospital cases were preventable. The study showed the need for primary prevention of accidents to decrease the number of victims (46 per cent) who died at the scene and those (23 per cent) who were dead on arrival at hospitals.
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This paper presents the preliminary results of the economic analyses of the National Hospice Study (NHS), mandated by the United States Congress to investigate the implications of including hospice services in Medicare. Data were collected over an 18-month period from approximately 4,000 patients receiving hospice and conventional terminal care in 25 hospices and 12 conventional care sites. Subsequent analysis may lead to changes in the specific results, and some of the differences may be due to confounding variables that cannot be adjusted for. ⋯ However, HB costs seem lower than conventional care costs only for patients with lengths of stay less than two months. Hospice and conventional care patients appear to differ with respect to predisposition toward intensive health care utilization. When this difference is explored more thoroughly in subsequent analyses, the estimated cost differential between hospice and conventional care may change.